As General Practitioners, our working day is largely determined by the demand from the public for healthcare, and our carefully planned schedule is never quite as we anticipated. Demand fluctuates with the season, epidemics and health scares. A typical day is hard to define. To be too precise about the working week and ‘clocking-off’ at 5pm calls into question the suitability of a trainee for General Practice. Overworking is also considered poor practice, whether it be due to an overenthusiastic trainee or an overbearing training host. Under the provisions of the Junior Doctors’ Contract (JDC) 2016 there are new rules on the working week and BMA guidelines to protect young doctors from abuse, tiredness, and improve patient-safety. Most GP-trainees within the WM region will be subject to the provisions of the JDC 2016 from August 2017. This guide is an HEE(WM) viewpoint and it should be remembered that every training practice is different and every trainee has differing educational needs.
Working Hours
The normal working day in General Practice is contractually defined as the period between the hours of 8.00am and 6.30pm Monday to Friday. In addition, a practice might be engaged in a contract to offer extended hours (e.g. 6.30pm to 8.00pm) and some may open 24-hours-a-day should they choose.
‘Out-of-hours’(OOH) is defined as the hours outside the normal working day (not including ‘extended hours’). Under the JDC 2016 a GP registrar is contracted to work a 40-hour week and there is no longer a supplement paid for OOH work. This time is therefore expected to be repaid retrospectively as time in lieu, usually within 1-2 weeks of the OOH session. Out of hours training for GP Registrars is expected to be arranged and performed at a rate of 6-hours per month resulting in a minimum total of 36hrs in ST2 and 72hrs in ST3. Work carried out as part of the host-practice’s ‘extended hours’ contract cannot be counted as OOH experience, even if it is carried out in the OOH period.
The 48-Hour Working Time Directive
GP registrars are governed by the 48-hour working time directive. This puts limits on the working week and is reflected in the JDC 2016. More details of the contract can be found here: http://www.nhsemployers.org/your-workforce/pay-and-reward/medical-staff/doctors-and-dentists-in-training.
Working pattern in GP Posts
Under the JDC 2016 a full-time week is defined as 40-hours (on average) including OOH training. A generic work schedule will be sent to you by the Lead Employer at least 6-weeks prior to each new training post and you will agree a personalised version of this schedule with your Clinical Supervisor at your placement planning meeting, early in the placement.
Your 40-hour working week will divided up as follows:
- 70% clinical hours, which may include (but not restricted to) booked and emergency surgeries, house visits, telephone consultations, associated administrative work, appropriate debriefing time with the supervising GP and OOH training.
- 30% educational hours, with two structured educational periods: which may include (but not restricted to) release to the local structured teaching programme, tutorials, practice educational meetings, educational supervisor meetings, activities relating to workplace based assessment, e-portfolio entries and other engagement with the Annual Review of Competence Progression process.
- A paid lunch-break per daytime shift (length of break depends on length of shift).
Educational and training opportunities will be tailored to address individual learning leads and on occasion, for educational purposes, it may be desirable for some of your nominally ‘educational’ hours to be used instead, for patient contact. This should be agreed with your educational (or clinical) supervisor, as appropriate.
When OOH training sessions are undertaken, the equivalent number of hours should be deducted from the daytime clinical hours in the same week (or following weeks) as agreed with the host-practice. The scheduling of OOH work must also remain compliant with the average 40-hour weekly total and ensure a safe working pattern in accordance with working time directive. Depending on the nature of the OOH work, the consequent time-off may need to be taken in one block during the same week (perhaps the same day or the next day), or it may be possible to take it in smaller amounts across several weeks; this should be agreed with your supervisor.
The host-practice must be given sufficient notice of the proposed OOH training session so that patient-care is not compromised. The timing of any time-off in lieu will need to be agreed with the host-practice, recognising the need to maintain safe working hours and must be agreed with the host-practice prior to the OOH work being undertaken.